Abstract
The prevalence of obesity among the populations of most developed countries has increased to such an extent that the healthcare and social security/disability system will accumulate direct and indirect costs related to obesity that will be more substantial than those for any other primary disease within this generation. For the past decade, the Healthcare Financing Agency, which oversees the Medicare and Medicaid programmes, has required all physicians and healthcare agencies serving beneficiaries of these programmes to include diagnoses using codes established by the ninth revision of the World Health Organization’s International Classification of Diseases. This coding system actually distorts data collection and undermines appropriate medical insurance reimbursement for the treatment of obesity.
Societal prejudices, inability of governmental agencies to address future concerns and the business community’s attempts to control healthcare costs without addressing the underlying issues contributing to these costs have led to confusion on how to confront this emerging epidemic. How will we develop the scientific knowledge and the political willpower to confront this epidemic? First, we need more accurate methods for classifying obesity and for measuring the cost of treatment. We can then determine if it is more cost effective to prevent or treat obesity early in its evolution or pay for its consequences in the form of treatment costs associated with its multiple comorbid diseases, such as hypertension, other cardiovascular disorders, diabetes mellitus, osteoarthritis and cancers, plus the lost productivity from absenteeism, premature retirement and death.
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References
Center for Disease Control Prevention. Cigarette smoking among adults — United States 1991. MMWR Morb Mortal Wkly Rev 1993; 43: 230–3
Hodgson TR. Cigarette smoking and life time medical expenditures. Milbank Q 1992; 70: 81–125
Calle EE, Thun MJ, Petrelli JM, et al. Body-mass index and mortality in a prospective cohort of U.S. adults. N Engl J Med 1999; 341: 1097–105
Allison DB, Fontaine KB, Manson JE, et al. Annual deaths attributable to obesity in the United States. JAMA1999; 282: 1530–8
Colditz GA. Economic costs of obesity. Am J Clin Nutr 1992; 55: S503–7
Levy E, Levy P, Le Pen C, et al. The economic costs of obesity: the French situation. Int J Obes 1995; 19: 790–2
Seidell JC, Deerenberg I. Obesity in Europe: prevalence and consequences for use of medical care. Pharmacoeconomics 1994; 5 (Suppl. 1): 38–44
Segal CL, Cartre R, Zimmet P. The cost of obesity: the Australian perspective. Pharmacoeconomics 1994; 5 (Suppl. 1): 45–52
Rissanen A, Heliovaara M, Knekt P, et al. Risk of disability and mortality due to overweight in a Finnish population. BMJ 1990; 301: 835–7
Narbro K, Jonsson E, Larwsson B, et al. Economic consequences of sick leave and early retirement in obese Swedish women. Int J Obes 1996; 20: 895–903
Flegal KM, Carro MD, Kuczmarski RJ, et al. Overweight and obesity in the United States: prevalence and trends 1960–1994. Int J Obes 1998; 22: 39–47
Seidell JC, Gijsen R, Bartelds AIM, et al. Obesity in Europe: scaling the epidemic. Int J Obes 1995; 19: S1–4
Barth N, Ziegler A, Himmelmann GW. Significant weight gains in a clinical sample of obese children and adolescents between 1985 and 1995. Int J Obes 1997; 21: 122–6
Coleman JA. Discrimination at large. Newsweek 1993 Aug 1; 9
Gortmaker SL, Must A, Perrin JM, et al. Social and economic consequences of overweight in adolescence and young adulthood. N Engl J Med 1993; 329: 1008–12
Horm J, Anderson K. Who in America is trying to lose weight? Ann Intern Med 1993; 119: 672–6
Williamson DF, Serdula MK, Anda RF, et al. Curent weight loss attempts in adults. Am J Public Health 1992; 82: 1251–7
Jindal B. Choice — sensitive health costs. J La State Med Soc 1997; 149: 62–7
Martin LF, Hunter S. How can we do better? Obes Res 1994; 2: 298–9
Gross CP, Anderson GF, Powe NR. The relationship between funding by the National Institutes of Health and the burden of disease. N Engl J Med 1999; 340: 1881–7
Varmus H. Evaluating the burden of disease and spending the research dollars of the National Institute of Health. N Engl J Med 1999; 340: 1914–5
Downey M. Director of the American Obesity Association: testimony at the House of Representatives subcommittee for prioritizing the 1999 budget for the NIH, 1999
Buchwald H. Mainstreaming bariatric surgery. Obes Surg 1999; 9: 462–70
Quesenberry Jr CP, Caan B, Jacobson A. Obesity, health services use, and healthcare costs among members of a health maintenance organization. Arch Intern Med 1998; 158: 466–72
Must A, Spadano J, Coakley EH, et al. The disease burden associated with overweight and obesity. JAMA1999; 282 (16): 1523–9
Martin LF, White S, Lindstrom Jr W. Cost-benefit analysis for the treatment of severe obesity. World J Surg 1998; 22: 1008–17
Lauve RM, Martin LF. What surgeons need to know to help patients receive quality medical care in managed care settings. Am J Surg 1997; 174: 542–58
Yanovski JA, Yanovski SZ. Recent advance in basic obesity research. JAMA 1999; 282: 1504–6
York DA. Peripheral and central mechanisms regulating food intake and macro nutrient selection. Obes Surg 1999; 9: 471–9
Shape Up America! & American Obesity Association. Guidance for the treatment of adult of obesity. Bethesda (MD): Shape Up America!, 1996
National Heart Lung and Blood Institute. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults; the evidence report. Washington, DC: U.S. Department of Health and Human Services, 1998
World Health Organization. Obesity: preventing and managing the global epidemic. Geneva: WHO, 1998
Cowan Jr GSM. The end of `morbid obesity’? Obes Surg 1999; 9: 417–8
Mokdad AN, Serdula MK, Dietz WH, et al. The spread of the obesity epidemic in the United States 1991–1998. JAMA1999; 282: 1519–22
Kiel U, Kuulasmaa K. WHOMONICA Project: risk factors. Int J Epidemiol 1989; 18: S46–55
Gortmaker SL, Dietz WH, Sobol AM, et al. Increasing pediatric obesity in the United States. Am J Dis Child 1987; 141 (5): 535–540
Chinn S, Rona RJ. Trends in weight-for-height and triceps skin fold thickness for English and Scottish children, 1972–1982, and 1982–1990. Pediatric Prenatal Epidemiol 1994; 8: 90–106
Troiano RP, Flegal KM. Overweight children and adolescents: description, epidemiology and demographics. Pediatrics 1999; 101 Suppl.: 497–504
Ramirez L. Type 2 diabetes striking more and more children. The Times Picayune 1999 Aug 12: A-16
Thompson D, Edelsberg J, Colditz GA, et al. Lifetime health and economic consequences of obesity. Arch Intern Med 1999; 159: 2177–83
Oster G, Thompson D, Edelsberg J, et al. Lifetime health and economics benefits of weight loss among obese persons. Am J Public Health 1999; 89: 1536–42
Allison DB, Zannolli R, Venkat Narayan KM. The direct health care costs of obesity in the United States. Am J Public Health 1999; 89: 1194–9
Greenway FL, Ryan DH, Bray GA. Pharmaceutical cost saving of treating obesity with weight loss medications. Obes Res 1999; 7: 523–31
MacDonald Jr KG, Long SD, Swanson MS, et al. The gastric bypass operation reduces the progression and mortality of non-insulin-dependent diabetes mellitus. J Gastrointest Surg 1997; 1: 213–20
Williamson DF, Pamuk E, Thun M, et al. Prospective study of intentional weight loss and mortality in never-smoking overweight US white women aged 40–64 years. Am J Epidemiol 1995; 141: 1128–41
Narbro K, Agren G, Jonsson E, et al. Sick leave disability pension before and after treatment for obesity: a report from the Swedish Obesity Subjects study. Int J Obes 1999; 23: 619–24
Sjostrom L, Narbro K, Sjostrom D. Costs and benefits when treating obesity. Int J Obes 1995; 19: S9–12
Bender R, Jockel K-H, Trautner C, et al. Effect of age on excess mortality in obesity. JAMA 1999; 281: 1498–504
Williamson DF. The prevention of obesity. N Engl J Med 1999; 341: 1140–1
Van Gemert WG. Adang EMM, Kop M, et al. A prospective cost-effectiveness analysis of vetical banded gastroplasty for the treatment of morbid obesity. Obes Surg 1999; 9: 484–91
Gold MR, Siegel JE, Russell LB, editors. Cost-effectiveness in health and medicine. New York (NY): Oxford University Press, 1996
Laupacis A, Feeny D, Detsky AS, et al. How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluations. Can Med Assoc J 1992; 146: 473–8
U.S. Department of Health and Human Services. Disability Evaluation Under Social Security. Washington, DC: U.S. Department of Health and Human Services, 1995: Social Security Administration Publication No. 64–039
Sargent JD, Blanchflower DG. Obesity and stature in adolescence and earnings in young adulthood analysis of a British cohort. Arch Pediatric Adolesc Med 1994; 148: 681–7
Sobel J. Marriage, obesity, and dieting. Marriage Fam Rev 1999; 7: 115–39
Kahn HS, Williamson DF, Stevens JA. Race and weight change in US women: the roles of socioeconomic and martial status. Am J Public Health 1991; 319–25
Harris MB, Harris RJ, Bochner S. Fat, four-eyed, and female: sterotypes of obesity, glasses, and gender. J Soc Psychol 1982; 12: 503–16
Crocker J, Cornwell B, Major B. The stigma of overweight: affective consequences of attributional ambiguity. J Personality Social Psychology 1993; 64: 60–70
Goodman WC. The invisible woman: confronting weight prejudice in America. Carlsbad (CA): Gurze Books, 1995
Erdman CK. Nothing to lose: a guide to sane living in a larger body. San Francisco (CA): Harper, 1995
Gill J. The fatness racket. The Times Picayune 1999 Sep 19: B-5
O’Brien PE, Brown WA, Smith A, et al. Prospective study of a laparoscopically placed, adjustable gastric band in the treatment of morbid obesity. Br J Surg 1999; 85: 113–8
Belachew M, Legrand M, Vicient V, et al. Laparoscopic adjustable gastric banding. World J Surg 1998; 22: 955–63
Martin LF, Tan T-L, Horn J, et al. Comparison of the cost associated with medical and surgical treatment of obesity. Surgery 1995; 118: 599–607
Fontanarosa PB. Patients, physicians, and weight control. JAMA 1999; 282: 1581–2
Bodenheimer T. Disease management: promises and pitfalls. N Engl J Med 1999; 340: 1202–5
Bodenheimer T. Disease management: correspondence and authors’ replies. N Engl J Med 1999; 341: 767–8
Spragins EE. Outsmarting and illness: choosing your own specialist is not the key to good care. Newsweek 1999 Mar 29: 82
Fontanarosa PB, editor. Obesity research: a JAMA theme issue. JAMA 1999; 282 (16): 1519–88
King R. Legislature mandates review panels for HMO plans: employers helped craft legislation. The Times Picayune 1999 Aug 29 1999: F1–2
Hsia D, Krushat M, Fagan AB, et al. Accuracy of diagnostic coding for Medicare patients under the prospective-payment system. N Engl J Med 1988; 318: 352–5
Jolis, JG, Ancukiewicz M, DeLong ER, et al. Discordance of databases designed for claims payment versus clinical information systems: implications for outcomes research. Ann Intern Med 1993; 119: 844–50
Hannan EL, Racz MJ, Jolis JG, et al. Using medicare claims data to assess provider quality for CABG surgery: does it work well enough? Health Serv Res 1997; 31: 659–78
Hunt, JP, Baker CC, Fakhry SM, et al. Accuracy of administrative data in trauma. Surgery 1999; 126: 191–7
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Martin, L.F., Robinson, A. & Moore, B.J. Socioeconomic Issues Affecting the Treatment of Obesity in the New Millennium. Pharmacoeconomics 18, 335–353 (2000). https://doi.org/10.2165/00019053-200018040-00003
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DOI: https://doi.org/10.2165/00019053-200018040-00003